Making the law enforcement-mental health connection

Multiple times a day, someone is killed by police in the United States, and many of those cases never even make the news (or social media). At least some of those people are mentally ill, though it’s really difficult to get exact statistics. When interactions between police and mentally ill people go bad, which they do, they go very, very bad, often very quickly — often, before police officers even arrive, when they’re prejudiced with a dispatcher’s comment that the subject is mentally ill and needs help. There’s no simple, easy, one-step solution to police violence in America — any solution must be intersectional in nature, and it must be multipart — but it is important to take a look at what is happening with police and mental illness in the United States, and to look at why it’s happening.

Are there more negative outcomes in interactions between police and mentally ill people than there used to be? This is actually a really hard question to answer. In the last year, it’s an issue that people seem to be becoming more aware of, which can boost the appearance of more negative interactions. But there are no hard statistics. And it’s complicated by the fact that rates of mental illness fluctuate (especially across demographic groups) and that rates of severe, untreated mental illness also fluctuate. Most police encounters involving mentally ill people that end in death involve people who have severe untreated mental illness, and that’s an important piece of this puzzle.

Why are so many people presenting with issues like severe depression, bipolar disorder, and schizophrenia? Is there an increase in incidence in the population? Again, this is also a little tricky to define — are more people being diagnosed? Are more people talking about these issues? We do know, however, that communities across the United States are experiencing severe mental health service cuts, which means that people who have mental illness are not getting access to early diagnosis and treatment, let alone services that will allow them to take control and decide how they want to manage their mental health conditions. The United States is also struggling with providing adequate care to veterans, and with persistent rates of homelessness (which can be a contributing factor to untreated mental illness, and vice versa).

Why are police interacting with them so frequently? Because, if we loop back to the above, there aren’t sufficient services to support them. Consequently, people are going into mental health crisis because they can’t get the care they need, and police are the only available responders, so despite the fact that they have little to no mental health training, they’re on the front lines of handling people who are in a very fragile psychiatric state.

Police aren’t mental health providers. They are supposed to be contributing to the safety and quality of life of the population, which can include being first responders in medical emergencies, but that’s not their primary goal. (Similarly, fire departments are taking huge numbers of medical aid calls due to cuts to EMS.) Some communities have started developing mental health crisis teams and a variety of programs to provide their officers with some basic tools for interacting safely and productively with mentally ill people, but this is an uphill process. In areas with spotty training, there’s no guarantee a trained officer will be on shift and available in a crisis.

Mental illness has in many ways become criminalised in the United States, and in some situations, it’s become a capital crime. This is the consequence of a series of factors that are present long before the police show up at a single incident involving a specific individual in crisis. Confronting the terrible rates of police violence against mentally ill people can’t just be about sensitivity training for police officers, though that’s certainly a tool.

It must include improving mental health coverage in the United States. People should be able to access comprehensive mental health services that allow them to be in control of their health, to choose modalities and options that work for them. This should be accessible to people of all social classes, provided in settings that offer other supports as well — the goal is to identify mental illness early, but it should also be to help people with SMI get stabilised and build their lives. For people with complex or treatment-resistant mental illness, this may take months or years, and they need continuing support to make sure their treatment is still working for them as they age.

This is not an endorsement of mandatory treatment laws and other compulsory mental health care measures embraced in some parts of the United States. These laws are abusive and they are not productive. We need to build a society in which mental health is not stigmatised, is part of whole-body health (which it is), and is in the patient’s control, not that of people around her. People should not be forced into medication, therapy, or any other treatment, nor should they be institutionalised for failing to comply with what society expects of them.

If you cut down on the number of people in a position to end up in mental health crisis, you cut down on the risk of interactions with police. But some people enter crisis no matter what, even with excellent mental health services — someone may hit a point that triggers an episode, may experience suicidal ideation, may have another issue that necessitates emergency help. When they, or a loved one, or a bystander, calls emergency services, they shouldn’t get police. They should get emergency medical services with psychiatric training, the people best able to help them. What about situations when people think they are a danger to themselves or others? A combination of law enforcement and EMS should be responding.

In the short term, we absolutely need to provide training to police to make these interactions less lethal. In the long term, we need to be working to make sure there’s no reason for police to show up in the first place, except in very extreme circumstances.

Image: Police, Kim Davies, Flickr